1. Which observation indicates that instruction given to nursing assistive personnel (NAP) in caring for a patient with an indwelling urinary catheter has been effective?

1. The collection bag has been placed on the side rail of the bed.
2. The excess catheter tubing has been coiled beside the patient’s inner thigh.
3. The collection bag has been placed on the bed.
4. The collection bag is held above the level of the bladder while ambulating the patient.

2. While setting up the sterile field in preparation for inserting an indwelling urinary catheter, a male patient is incontinent of urine over most of the supplies. What action would the nurse take to reduce the patient’s risk for infection?

1. Rinse off the supplies that were contaminated with urine.
2. Cleanse the patient’s urinary meatus.
3. Replace all contaminated supplies, and begin the process again.
4. Change the patient’s bed linens.

3. When collecting a urine specimen from an indwelling urinary catheter, which action is most likely to ensure that sufficient urine is collected?

1. Checking the patency of the indwelling catheter tubing
2. Placing the urinary collection bag below the level of the bladder
3. Clamping the catheter tubing for 15 minutes before collection
4. Asking the patient to drink a glass of water 30 minutes before the collection

4. Which instruction might the nurse give to nursing assistive personnel (NAP) helping to care for a patient receiving bladder irrigation?

1. “Tell me how he tolerates the irrigation.”
2. “Be sure to check for signs of a urinary tract infection.”
3. “Measure and report the patient’s temperature to me every 4 hours.”
4. “Ask the patient about pain level.”

5. Which action will the nurse implement to reduce the risk of catheter-associated urinary tract infection (CAUTI) in a male patient with an indwelling urinary catheter?

1. Frequently pull on the drainage system tubing.
2. Use the largest-size catheter possible.
3. Clean the urinary meatus daily.
4. Apply antiseptics to the urinary meatus.

6. Which action would the nurse take to minimize a patient’s risk for injury during urinary catheter irrigation?

1. Change the tubing every 8 hours.
2. Use slow, even pressure when injecting the irrigating fluid.
3. Adhere to aseptic technique during the irrigation process.
4. Monitor the patient’s temperature every 4 hours.

7. Which action would the nurse take to reduce the risk for a catheter-associated urinary tract infection (CAUTI) in a patient with an indwelling urinary catheter?

1. Wear clean gloves when inserting the catheter.
2. Inflate the balloon on the catheter before using it.
3. Use the smallest-size catheter possible.
4. Empty the urine by disconnecting the catheter from the collection bag.

8. When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what?

1. Remove the cotton balls from the kit for later use.
2. Advance the catheter 10 to 12 inches or until urine flows.
3. Lubricate the first 5 to 7 inches of the catheter.
4. Hold the penis at a 45-degree angle during insertion.

9. The nurse instructs nursing assistive personnel (NAP) regarding proper technique for intermittent straight catheterization of a male patient. Which statement made by NAP indicates that the instruction was effective?

1. “I’ll help you set up the sterile field.”
2. “I’ll get a sterile urine cup for you.”
3. “There are leg straps in the utility room.”
4. “I’ll help keep his legs away from the sterile field.”

10. Which measure may be taken to minimize the staff’s risk for infection from a urine specimen?

1. Firmly securing the lid of the urine specimen container
2. Using a sterile urine specimen container
3. Using a sterile syringe to access the sampling port
4. Placing the urine specimen container in the refrigerator until the laboratory comes to get it

11. Which action would the nurse take to manage continuous urinary catheter irrigation for a patient whose urine is bright red and contains clots?

1. Increase the irrigation drip rate.
2. Notify the patient’s health care provider of the blood and clots in the urine.
3. Encourage the patient to increase fluid intake.
4. Apply ice to the patient’s lower abdominal area.

12. A patient with a suprapubic catheter is complaining of pain. What will the nurse do first to help this patient?

1. Ensure that the patient is not lying on the drainage tubing
2. Instruct the patient to increase his or her oral fluid intake
3. Observe the rate of drainage in the urine collection bag
4. Notify the health care provider

13. When preparing to discharge a patient who had an indwelling urinary catheter removed 24 hours ago, the nurse would offer patient education regarding which common complication?

1. Urinary incontinence
2. Urinary tract infection
3. Adequate oral hydration
4. Kidney stones

14. Which nursing action reduces the risk of injury in a patient with a suprapubic catheter?

1. Applying sterile gloves before cleaning the catheter insertion site
2. Cleansing the skin surrounding the insertion site
3. Securing the catheter to the abdomen
4. Keeping the drainage bag above the level of the patient's bladder

15. What is the primary reason the nurse applies sterile gloves rather than clean ones when caring for a patient with a newly inserted suprapubic catheter?

1. To protect the nurse and other patients from pathogens
2. To collect a sterile urine sample
3. To reduce the patient's risk of infection
4. To reduce the patient’s risk of injury

16. Which nursing action minimizes a patient’s risk for injury during removal of an indwelling urinary catheter?

1. Using a 5-mL syringe to deflate the balloon
2. Using sterile scissors to cut the valve to deflate the balloon
3. Tugging gently on the catheter to pull the balloon through the urethra
4. Checking the documentation for the volume of fluid used to inflate the balloon

17. Which action would best minimize a patient’s risk for infection during removal of an indwelling urinary catheter?

1. The nurse or nursing assistive personnel (NAP) removing the catheter must employ clean technique.
2. A registered nurse, not NAP, must remove the catheter.
3. Catheter removal must be executed within 10 minutes of beginning the procedure.
4. Catheter removal must take place within 5 days of catheter insertion.

18. Which action is most important in reducing the risk for infection in a patient receiving open intermittent irrigation of a urinary catheter?

1. Attaching the urinary drainage bag to the bed frame
2. Inspecting the drainage tubing for kinks
3. Disposing of contaminated items after the procedure
4. Cleaning the end of the drainage tubing with an antiseptic wipe before reconnecting it to the catheter

19. The nurse has completed an intermittent straight urinary catheterization of a female patient. Which action would the nurse delegate to nursing assistive personnel (NAP)?

1. Measure and empty the urine.
2. Palpate the abdomen.
3. Ask the patient if she has any pain.
4. Document the procedure.

20. While performing an intermittent straight urinary catheterization of a female patient, the nurse inadvertently inserts the catheter into the patient’s vagina. Which action would the nurse take next?

1. Remove the catheter, and rinse it thoroughly in sterile water for reuse.
2. Keep the catheter in place, and begin again with a new sterile catheter.
3. Remove the catheter, relubricate it, and insert it into the urinary meatus.
4. Stop advancing the catheter, and notify the health care provider.

21. Which statement might the nurse make to nursing assistive personnel (NAP) assigned to care for a patient with an established suprapubic catheter?

1. "Tell me if the catheter site looks inflamed."
2. "I need to know the patient's temperature each time it's taken."
3. "Wear sterile treatment gloves when you remove the dressing."
4. "Let me know if the patient's catheter is infected"

22. A newly inserted suprapubic catheter becomes dislodged. What action should the nurse perform first?

1. Notify the health care provider
2. Apply pressure over the site
3. Cover the site with a sterile dressing
4. Help the patient into a side-lying position

23. While attempting to perform a straight catheterization for a male patient, the nurse advances the catheter 3 to 4 inches into the meatus but observes no urine flow. Which action would the nurse take at this time?

1. Continue to advance the catheter until 5 to 7 inches of the catheter tube has been introduced into the urethra.
2. Withdraw the catheter to 1 inch, and ask the patient to cough.
3. Encourage the patient to cough as the catheter is advanced.
4. Apply pressure to the patient’s lower abdomen over the bladder.

24. Which statement might the nurse make to nursing assistive personnel (NAP) caring for a patient who has just had an indwelling urinary catheter removed?

1. “Teach the patient the signs of a urinary tract infection.”
2. “Tell me when and how much the patient first voids.”
3. “Explain that voiding might be uncomfortable for 4 to 5 days.”
4. “Assess the patient for a distended bladder before the end of the shift.”

25. Which statement might the nurse make to nursing assistive personnel (NAP) before delegating the collection of a routine urine sample from a patient with an indwelling urinary catheter?

1. “Does the patient understand why the specimen is needed and why we cannot obtain it from the Foley bag?”
2. “See if the catheter is causing the patient any problems and if he is having any pain.”
3. “Please get two sterile urine collection containers from the utility room.”
4. “Let me know if the urine contains blood or sediment, or appears cloudy.”

26. What is the best reason for the nurse to instruct a male patient to take slow, deep breaths during insertion of an indwelling urinary catheter?

1. To increase oxygenation
2. To reduce blood pressure
3. To distract him
4. To promote relaxation

27. During intermittent open bladder irrigation, a patient complains of pain. Which action would the nurse take first?

1. Examine the drainage tubing for clots, sediment, and kinks.
2. Notify the health care provider.
3. Leave the irrigation drip wide open.
4. Monitor the patient’s vital signs.

28. A female patient placed in the dorsal recumbent position for the insertion of an indwelling urinary catheter tells the nurse that she “doesn’t feel comfortable in this position” and that her “back really hurts.” What is the nurse’s best response?

1. Reassure the patient that the procedure will take only a few minutes.
2. Promise to reposition the patient as soon as the catheter has been inserted.
3. Reposition the patient in a side-lying position, with her upper leg flexed at the knee and hip.
4. Explain to the patient that the position will allow the catheter insertion to be more efficient.

29. The nurse has completed the initial inspection of the patient’s perineum and is preparing to insert an indwelling urinary catheter. Which action would the nurse complete next?

1. Begin to establish a sterile field.
2. Open and assemble the urine drainage bag.
3. Remove soiled gloves, and perform hand hygiene.
4. Center the drape over the patient’s labia.

30. Which action(s) would minimize the patient’s risk for injury during insertion of an indwelling urinary catheter?

1. Assessing the patient for allergies related to latex, antiseptic, tape, and/or iodine-based substances
2. Thoroughly cleansing the patient’s perineal area with povidone-iodine solution before inserting the catheter
3. Performing proper hand hygiene and applying gloves before inserting the catheter
4. Terminating the insertion if the patient reports pain at any time during the procedure

31. Why does the nurse need to keep the urine sterile while obtaining a sample from an indwelling urinary catheter?

1. Sterile technique protects the patient from microorganisms in the urine.
2. Sterile technique protects the nurse from microorganisms in the urine.
3. Sterile technique reduces the amount of pain caused by the procedure.
4. Sterile technique ensures that microorganisms in the specimen are from the urine, and not the result of contamination.

32. Which action will ensure that a sterile urine specimen is handled properly in order to help obtain reliable results?

1. Placing the specimen in a biohazard bag
2. Having someone take the specimen to the lab immediately
3. Cleaning the outside surface of the container
4. Ensuring that a stock of sterile urine collection kits is available

33. Why does the nurse cleanse a female patient’s perineum before inserting an intermittent urinary catheter?

1. To encourage the bladder to drain fully
2. To encourage spontaneous voiding
3. To prevent bowel elimination during the procedure
4. To reduce the patient’s risk of urinary tract infection

34. Which is not an expected outcome on a first voiding after catheter removal?

1. Mild burning
2. Fever and back pain
3. Producing only a small amount of urine
4. Discomfort

35. Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) when inserting an indwelling urinary catheter in a female patient?

1. “Please direct the light to better illuminate the patient’s perineal area.”
2. “You need to be comfortable inserting a catheter in a patient of her size.”
3. “See if a size 14-French catheter is big enough.”
4. “Find out if the patient has any allergies to latex or iodine.”